Interactive: Measuring Taxpayer-Funded Weight-Loss Surgeries in Texas

Despite lawmakers' efforts to cinch the belt on health care costs, state and federal spending on weight loss surgeries in Texas is bulging. The Texas Tribune's analysis of state and federal health care data found spending on bariatric surgeries covered by Medicare and Medicaid in Texas tripled between 2007 and 2010, from $1 million to $3 million, while the number of procedures performed nearly doubled. For more on the rise of taxpayer-funded weight-loss surgeries in Texas, check out Emily Ramshaw's report here.

You can click on the legends to add or remove a program from view in each of the graphs. Try it out by clicking off "Medicare" in both legends. Now it's easier to compare the difference in claims and costs for two methods of paying Medicaid providers: fee for service and managed care. The jump in Medicaid costs can be explained by supplemental payments the state paid to managed care plans, which get paid set premiums and faced unanticipated costs due to the state’s decision to more widely cover bariatric procedures. Those payments ended last year, and the state expects big savings.

McAllen takes the cake for billing Medicaid for more weight-loss procedures than any other city under the fee for service structure. The border region does have the highest rate of residents enrolled in Medicaid. But urban Dallas, which had the second-highest number of bariatric patients, is home to at least a million more people than McAllen, according to 2010 population data. Even if you add in the number of Medicaid patients in Dallas County managed care plans who had bariatric surgeries during the same time period — two — McAllen still billed for 62 more surgeries.

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Rene for many people, surgery is the best option. And it's cheaper for us ton invest in the health of these people up front, than to continue paying for weight-related medical costs. You must have missed the part in the article where bariatric surgery pays for itself in a relatively short time, within 18 months to 3 years.

Or they could not let it get to the point where they get surgery. Weight gain is largely psychological (except in the tiny amount of people who have a medical condition that causes weight gain). Surgery does not address the psychological reasons why these people are obese. Many gain the weight back and if not, many need several follow up visit to monitor their progress and those aren't free.

What would be nice is if healthier food options were not more expensive than junk food, which is a huge part of the obesity problem. If the surgery is done without a change in diet and lifestyle, then it's pointless. I hope there is also an education component to this surgery.

Rene it's far more complicated than you realize, but how swell for you to let people get ill and likely die. A huge problem, which needs to be addressed is the lack of healhy and affordable foods for so many, esp in poor parts of the state. It's easy to say things like eat more frits and vegetables when you have them readily availale, without stopping to think that so many don't. Then there's our government's obssession with subsidizing corn, which leads to things like high fructose corn syrup in everything, and those foods are very cheap to buy. Studies have shown than hfcs is an addictive substance that's very hard for our bodies to metabolize. There are also issues of time for poor people, who usually work more hours than most of us just so they can provide for their families. That can make it harder to have the time even to prepare healthy meals assuming they do have access to healthy foods. Weight issues are very complicated, so I suggest you try to educate yourself a little, and perhaps stop being so judgmental.

@Renee: Yes, for some patients surgery is the best option, but not for most. And the fact that McAllen Texas has more surgeries than anyplace else in the state indicates many of those surgeries are not based on need or what is best for the patient. The problem with any government-managed health insurance program is that it gets abused. A chiropractor in Fort Bend was just convicted of fraud; she billed medicare/medicaid over $8 million for unnecessary services. http://www.yourhoustonnews.com/ranch/news/fort-bend-chiropractor-sentenced-to-federal-prison-for-medicare-fraud/article_4a0181b2-9083-54b2-8ccb-5d2dce79b5a5.html When the patient isn't paying the bill there is little incentive to watchdog the costs.

I would love to hear an explanation from one of my economist friends as to why the costs for MANAGED CARE increased so much more than the fee-based services. Isn't managed care the holy grail of keeping health care costs down?

Renee, I agree that the food industry is a big part of the problem. Yet our government and FDA don't seem willing to do anything about it. I also agree that the healthier food options for low-income people are sorely lacking. Just drive around low-income neighborhoods and it's quite apparent with all the fast food places. The same goes for the grocery stores in low-income areas. There is a noticeable difference in what they stock. Yes, obesity is a complex issue.

Vegetables are far cheaper than meat which is related to many illnesses including cancer, sure sodas are cheap but even water is cheaper if you buy it at 25cents a gallon. Please dont tell me its hard to shop healthy in poverty. Im a college student, you dont get must poorer with little time to cook than that.

Rene, you're making a lot of assumptions about access to bealthy and affordable foods. As a college student, something many poor will never be, you should have the tools to expand your knowledge and perhaps break outside of your preconceived notions.

Managed care is more costly dur to the policies set in place for care. Many HMO's require a referral from PCP to see a specialist. One may have to visit the ER before the above steps are finished. And of course fraud, or even tests and diagnostics that may or may not be needed.

'There is no single diet that helps patients lose weight and keep it off.' what a stupid uneducated statement. Of course there is. It's called the shopping right and eating right diet and it's so affordable it can easily be done with SNAP with or without food bank type supplements. Living in south central Texas it is impossible not to know obese people and I can tell you that if not all, 99.9% of them absolutely consume the wrong foods and way too much of it. The poorest parts of my city are chock-a-block with fast food restaurants and Tex-Mex joints and they are making money hand over fist. Every once in a while I go to one of the big Texas based grocery stores in those areas and I cannot buy there what I buy in the stores in higher income areas. And why is that? Because no business is going to waste valuable shelf space on items that do not sell - and I don't blame them for that. If their regular patrons requested a change and followed through with on-going regular purchases they would stock it. No, bariatric surgery should be very rare.

I'm ok with covering the surgeries; but my problem is if it is approved in three-four weeks, its not being done for long-term changes. See, my heath insurance covers bariatric surgery at an 80% rate. Prospective patients have to meet the same guidelines as mentioned in the article; but, they have to do six months of classes and appointments about canges to the was they will eat after the surgery. If they miss an appointment, they have to start over. This makes it difficult to get thesurgery, but it also puts the onerus on the individual to commit to changing. I'd like to know if these classes were required before medicaid paid for the sutgeries. If not, then how do the people learn to change their diets after?

So self righteous all of these people.We pay for people who get drunk and get into accidents, people with unplanned pregnancies, smokers who need byass surgery and chemo for cancer etc etc - this ends up saving us money- unfortunately humans are not that great with the self control.